Japanese doctor-patient discourse : an investigation into cultural and institutional influences on patient-centred communication.

Abstract

This thesis investigates how Japanese doctors create and maintain patient-centred consultations through their verbal interaction with patients, and the extent to which features of Japanese interpersonal communication influence the institutional discourse. Audio recordings of 72 doctor-patient interactions were collected at the outpatient department of a Japanese teaching hospital. All consultations involved new cases. There were two kinds of consultations: a preliminary history-taking interview with an intern and a diagnostic consultation given by an experienced doctor. After transcribing the recordings sequences of the discourse were analysed qualitatively on a turn-by-turn basis and a corpus of the data was analysed quantitatively to establish frequencies of discourse features related to patientcentredness. A review of literature (Chapter 2) establishes the standard structure of medical consultations and the relationship of the doctor and patient during consultations in terms of the asymmetry of speaking initiative according to consultation phases. The second part of Chapter 2 is an examination of Japanese communication style, attested to be influenced by culturally specific norms of behaviour that are demonstrable through verbal interactions. Chapter 3 describes the research method, and this is followed by four chapters of analysis. Chapter 4 describes the nature of the two kinds of consultations; the phases they include, and how the participants shift from one phase to the next with phase transition markers. Particular attention is paid to opening and closing phases, as they are most relevant to the establishment and consolidation of a patient-centred relationship. Chapter 5 investigates patterns of questioning by doctors, identifying functional categories of questions to see how they are used to coax information from the patient. Chapter 6 examines how the doctor encourages the patient’s narrative through backchanneling; how the doctor accommodates the patient through sensitive explanations of treatments and procedures; and how the voice of the patient emerges through calls for clarification, and voicing concerns. Chapter 7 highlights discourse sequences that may indicate culturally specific influences, and examines the emergence of laughter as an indicator of Japanese interpersonal interaction. The features of these Japanese consultations are consistent with medical consultations described in English speaking settings regarding phases and the discourse strategies used to achieve patient-centredness. While there appear to be Japanese cultural influences in the interactions consistent with previous cross-cultural studies the author argues that the institutional setting (clinical framework) is more immediately relevant to the conversational dynamics of the interactions than the Japanese cultural setting. Finally, medical consultations involving new cases have more features of service encounters and therefore not controlled by the guidance-cooperation model of doctor-patient interaction.